Imaging the GI tract and cases

Question 1

Often exacerbated by eating

+/- deranged LFT’s

Answer 1

Cholecystitis/Biliary Colic

Question 2

First line investigation for Cholecystitis/Biliary colic

Answer 2

US

-further clarification with MRCP &/or ERCP

Question 3

Epigastric/Diffuse abdominal pain
Elevated serum Amylase
Multiple causative factors, most commonly Alcohol or Gall Stones

Answer 3

Pancreatitis

Question 4

When is best to assess for complications of pancreatiits?

Answer 4

Best performed around 1 week following onset of symptoms

• this group of patients can require lots of imaging with a resultant high radiation dose
  e. g. pseudocyst

Question 5

First line investigation for perforation?

Answer 5

Erect x-ray
(perforation will show subphrenic gas)
CT may help delineate source & show further features such as intra-peritoneal collections

Question 6

Central abdominal pain, later localising in RIF

May be associated with fever & elevated inflammatory markers

Answer 6

Appendicitis

In FEMALES, consider gynaecological pathology
First line investigation = ultrasound. Confirm diagnosis, find alternative cause

Question 7

Lower abdominal pain, classically LIF
Associated diarrhoea +/- PR bleeding
Elevated inflammatory markers

Answer 7

Diverticulitis

Question 8

Diverticulitis investigation?

Answer 8

CT

Question 9

Distended abdomen and you suspect bowel as source, which investigation?

Answer 9

AXR

Question 10

Distended abdomen and you suspect fluid, what is your first line investigation?

Answer 10

Ultrasound

Question 11

Radiological investigation of haematemesis?

Answer 11

complements endoscopy

• image WHEN bleeding
• CT with IV contrast, NO oral contrast
• +/- angiography & intervention

Question 12

Investigation for change in bowel habit?

Answer 12

Radiological investigation = Barium enema or CT virtual Colonography

Often to complete visualisation of RIGHT colon further to Flexible Sigmoidoscopy

Question 13

Investigation for inflammatory bowel disease?

Answer 13

Endoscopy

-Fluoroscopic contrast studies if small bowel disease suspected: strictures, wall thickening, fistulation

Question 14

use in known cases of small bowel Crohn’s or Large bowel Crohn’s with suspected small bowel involvement?

Answer 14

Small bowel MRI

Question 15

If known inflammatory bowel disease, how would you check whether bowel disease was active?

Answer 15

Radio-labelled white cell scan (can localise inflammation)

Abnormal uptake on early and late scans can be localised with SPECT-CT

Question 16

First line investigation for jaundice?

Answer 16

Ultrasound

MRCP +/- ERCP to further investigate

Question 17

Multiple hypoechoic, but solid liver lesions. Varying sizes.

Some with a ‘target’ appearance

Answer 17

Liver metastases

Question 18

Nodular contour and coarse echotexture

Small volume of ascites

Answer 18

Cirrhosis